INTRODUCTION: Appendectomy for acute appendicitis is the most common surgical procedure performed during pregnancy. The primary treatment for acute appendicitis is emergency surgery, which can be particularly challenging due to altered anatomical conditions. Preoperative and postoperative care may require certain examinations due to pregnancy that are not standard within surgical practice or may be overlooked by the attending gynecologist. CASE PRESENTATION: A patient at 31 weeks of gestation presented to the obstetric clinic with an acute onset of acute appendicitis. After completing all necessary examinations and a thorough multidisciplinary evaluation, a successful laparoscopic appendectomy was performed. The subsequent hospitalization was complicated by the onset of uterine contractions, for which tocolysis was administered in combination with corticosteroid therapy to induce fetal lung maturity. CONCLUSION: In the presented case report, we demonstrate an example of the appropriate multidisciplinary approach with an analysis of the specific steps that should be taken to maximize the benefit for both the fetus and the mother, as well as the surgical team. In the discussion, we outline the steps that should be followed for patient benefit and forensic reasons.
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: This study aimed to evaluate the effectiveness of different tracers ́ application techniques for sentinel lymph node (SLN) detection in women with endometrial cancer undergoing laparotomy. Additionally, potential risk factors for SLN detection failure were assessed. METHODS: We retrospectively analyzed data from 248 endometrial cancer patients who underwent abdominal surgery with SLN mapping between January 2020 and March 2024. Statistical analyses were conducted using the Wilcoxon rank sum test for continuous variables and either Pearson's chi-square test or Fisher's exact test for categorical variables, with a significance level set at p < 0.05. RESULTS: Group I + S consisted of 147 women with intracervical and subserosal tracers ́application and group I + I included 101 women with intracervical and intrafundal application. Successful detection of SLN on both sides was achieved in 39.9% (99/248) of all patients, in 38.1% (56/147) in the I + S group and in 42.6% (43/101) in the I + I group, respectively. SLNs were identified in 32.7% (81/248) of all patients on only one side of the pelvis, in 31.3% (46/147) in the I + S and in 34.7% (35/101) in the I + I group, respectively. No SLNs were detected in 27.4% (68/248) of all subjects, comprising 30.6% (45/147) from the I + S and 22.8% (23/101) from the I + I group. Although the success rate of SLN detection was higher in the I + I group and on the right side of the pelvis regardless of the detection method, these differences were not statistically significant. An age exceeding 66.3 years was recognized as a critical risk factor for successful detection, other followed factors did not demonstrate a statistically significant impact on overall detection success. Additional significant risk factors were identified: depth of tumor myometrial invasion on the right side, history of pelvic surgery, and total tumor volume on the left side. CONCLUSIONS: The study did not reveal significant differences in SLN mapping success between the groups receiving intracervical + intrafundal and intracervical + subserosal tracers ́applications among endometrial cancer patients treated via open surgery. Overall, older age emerged as the most critical risk factor for SLN detection failure, while other assessed factors did not show a statistically significant impact on overall detection success. TRIAL REGISTRATION: Institution University Hospital Královské Vinohrady, Prague, Czech Republic. REGISTRATION NUMBER: EK-VP-21-0-2023. Date of registration 7-JUN-2023. This study was retrospectively registered in compliance with the Declaration of Helsinki.
- MeSH
- biopsie sentinelové lymfatické uzliny * metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické metastázy MeSH
- nádory endometria * chirurgie patologie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sentinelová uzlina * patologie diagnostické zobrazování chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Negative pressure wound therapy (NPWT) is a very effective method in the treatment of dehiscent, infected, and non-healing wounds. Difficult wound healing occurs especially in late pregnancy due to the rapid enlargement of the uterus and the constantly increasing tension of the entire abdominal wall. In cases of dehiscence of the surgical wound during pregnancy, proper subsequent treatment is needed, where it is necessary to consider the safety of the mother as well as the fetus. We report the case of a 30-week pregnant patient who was surgically treated for acute appendicitis in pregnancy with an open appendectomy approach. Postoperative complications resulted in wound dehiscence with complete defect in fascia, which was treated with negative V.A.C. ATS® Therapy System. The therapy was started in the 30th week of pregnancy and continued until delivery with regular check-ups and regular redressing of the vacuum-assisted closure (VAC) system. At 38 weeks of pregnancy, the patient delivered vaginally with continued VAC therapy in situ. The final suture took place 3 days after vaginal delivery. Non-healing wounds with abdominal wall defects should be treated using a multidisciplinary approach, and NPWT can be used. This therapy can also be used during pregnancy. Vaginal delivery is preferred because it reduces the risk of further formation or deepening of the abdominal wall defect after a sufficient time interval from the start of the treatment. This complex case with a literature review of surgical complications in pregnancy treated with NPWT therapy highlights the advantage of a multidisciplinary approach.
- MeSH
- apendektomie * škodlivé účinky MeSH
- apendicitida chirurgie MeSH
- dehiscence operační rány * terapie etiologie MeSH
- dospělí MeSH
- komplikace těhotenství * chirurgie MeSH
- lidé MeSH
- těhotenství MeSH
- terapie ran pomocí řízeného podtlaku * metody MeSH
- vedení porodu metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Tubární potrat představuje vypuzení plodu z vejcovodu do dutiny břišní. Může být kompletní nebo nekompletní s rezidui přetrvávajícími ve vejcovodu. Jedná se o formu mimoděložního těhotenství, jejíž incidenci nelze přesně stanovit. Rozpoznání případů tubárního abortu je zásadní v péči o pacientku, protože může vést ke konzervativnějšímu přístupu. Diagnóza by měla být stanovena kombinací ultrazvukového vyšetření, hladiny b-hCG a peroperačního nálezu. Článek popisuje případ 30leté pacientky přijaté pro suspektní mimoděložní graviditu, kdy ultrazvukové vyšetření prokázalo masu připomínající tubární graviditu vedle dělohy a hladiny b-hCG byly 111,8 U/l. Peroperačně byl zjištěn tubární abort v Douglasově prostoru umožňující zachování obou vejcovodů. Histopatologický rozbor potvrdil klinickou diagnózu. Konzervativní přístup může mít dostatečný efekt v případě tubárního abortu, což umožňuje zachování fertility a tubárních funkcí.
Tubal abortion is characterized by the extrusion of the foetus into the abdominal (peritoneal) cavity. It can either be a complete extrusion or incomplete with residual tissue remaining in the fallopian tube. It is a type of ectopic pregnancy that is difficult to determine the exact incidence of tubal pregnancies. Identifying cases of tubal abortions is crucial for individualized care since it can lead to a more conservative treatment approach. The diagnosis should be based on ultrasound imaging, b-hCG levels and visual conformation during exploratory surgery, either open or laparoscopic. The article describes the case of a 30-year old patient who presented with lower abdominal pain and was admitted for a suspected ectopic pregnancy. Ultrasound imaging showed a mass resembling a tubal pregnancy next to the uterus with b-hCG levels of 111.8 U/L. During laparoscopic surgery, a tubal abortion was detected in the pouch of Douglas (Rectouterine pouch). This finding led us to preserve both fallopian tubes. Histopathology confirmed our clinical findings. A conservative approach can be sufficient in case of tubal abortions, which can lead to preserved fertility and tubal functions.
- MeSH
- dospělí MeSH
- Douglasův prostor diagnostické zobrazování patologie MeSH
- gynekologické chirurgické výkony metody MeSH
- laparoskopie MeSH
- lidé MeSH
- lidský choriogonadotropin, beta podjednotka analýza MeSH
- mimoděložní těhotenství * chirurgie diagnostické zobrazování patologie MeSH
- salpingektomie MeSH
- samovolný potrat * chirurgie diagnostické zobrazování patologie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- uterus diagnostické zobrazování patologie MeSH
- vejcovody chirurgie diagnostické zobrazování patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION AND HYPOTHESIS: The main risk factor for pelvic floor disorders is vaginal delivery, which may cause levator ani muscle (LAM) injury and denervation. LAM includes pubovisceral muscle (PVM, pubococcygeus), puborectalis muscle (PRM), and iliococcygeus muscle. We hypothesize that primiparous women with low pelvic floor muscle contraction have a reduced PVM cross-sectional area (CSA) compared to nulliparous women. METHODS (SAMPLE SIZE AND STATISTICAL APPROACHES): This single-centre prospective observational study compared healthy nulliparous (n = 40) to primiparous (n = 40) women after vaginal delivery without LAM avulsion and Oxford score ≤ 3. Demographics, questionnaires (ICIQ-UI-SF, OAB-Q-SF, PISQ-12), POP-Q, Oxford score, ultrasound measurements (minimal anteroposterior and lateral diameters, hiatal area, PRM thickness, levator-urethra gap) and magnetic resonance imaging (MRI)-PVM CSA were evaluated. Normality was tested, and an appropriate test was used to compare the groups. Power calculation suggested 40 participants per group. RESULTS: The primiparous group was older, had a higher BMI, and their hiatal area on ultrasound at contraction was larger compared to the nulliparous group. The CSA of the left-sided PVM (1.15 ± 0.50 cm2) was larger compared to the right side (1.03 ± 0.50 cm2), p = 0.02 in nulliparous women. The PVM CSA of primiparous women with low Oxford score was reduced compared to nulliparous (0.87 ± 0.30 versus 1.09 ± 0.50 cm2, p = 0.006). The intra-rater reliability for PVM CSA had an ICC of 0.90 and inter-rater ICC of 0.77. CONCLUSIONS: Primiparous women after vaginal delivery with low pelvic floor contraction force had reduced PVM CSA on MRI images compared to nulliparous women.
- MeSH
- dospělí MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- onemocnění dna pánevního diagnostické zobrazování etiologie MeSH
- pánevní dno * diagnostické zobrazování MeSH
- parita * MeSH
- prospektivní studie MeSH
- svalová kontrakce fyziologie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- vedení porodu MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
PURPOSE: The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2-S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. METHODS: Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. RESULTS: Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. CONCLUSION: Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.
- MeSH
- disekce MeSH
- iatrogenní nemoci MeSH
- kloubní ligamenta MeSH
- lidé MeSH
- mrtvola MeSH
- pánev MeSH
- pudendální nerv * anatomie a histologie MeSH
- pudendální neuralgie * chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Očkování v těhotenství a během kojení je velmi diskutovaným tématem současné doby. Nutnost vakcinace těhotných narůstá s rozšířením dalších, nebezpečnějších mutací viru SARS-CoV-2. Tyto varianty významně zvyšují riziko maternálních i neonatálních komplikací. Ve studii jsme se pomocí dotazníků snažili zjistit podrobnosti o informovanosti těhotných žen o SARS-CoV-2 vakcinaci. Mezi dotazovanými těhotnými bylo 58 % očkováno alespoň jednou dávkou vakcíny, 51 % bylo očkováno kompletním očkovacím schématem. Zvýšené riziko průběhu SARS-CoV-2 u těhotných oproti netěhotným uvádí 77 % dotazovaných a 71 % uvedlo, že je plod ohrožen úmrtím. I přes relativně vysokou informovanost dotázaných těhotných (informováno bylo 87 %) je třeba prezentovat konkrétní výhody očkování nejen mezi gynekology, ale zaměřit se i na lékaře ostatních oborů, kteří mohou ženy k očkování pozitivně motivovat.
Vaccination is a widely discussed topic during pregnancy and breastfeeding. Due to newly emerging covid-19 variants, vaccination has become more and more important. These new variants pose a risk for the development of maternal and neonatal complications. The aim of this study was to conduct a survey among pregnant women to assess the awareness of covid-19 and vaccination. Among the respondents, 58% were vaccinated with at least one dose and 51% were fully vaccinated. Also, 77% percent of responders thought that there was an increased risk of severe covid-19 infection among pregnant women versus non-pregnant women, while 71% were aware of the risk of fetal death associated with covid-19 infection. Although the rate of awareness among pregnant women is quite high (up to 87%), it is crucial to present the advantages of vaccination among gynecologists and doctors of other specialties as they are able to motivate women to be vaccinated.
